Heart Failure: Symptoms, Diagnosis and Treatment Options

What is Heart Failure?

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Heart failure occurs when the heart’s pumping function is impaired, preventing organs and tissues from receiving adequate blood and oxygen. This condition is also known as “congestive heart failure” because it often presents with fluid accumulation (congestion) in the body.

Heart failure can develop suddenly (acute) or progress slowly (chronic). Chronic heart failure typically develops over years and may worsen over time.

Types of Heart Failure

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Heart failure is classified according to the affected heart chamber and pumping capacity:

1. Left-Sided Heart Failure

• HFrEF (Reduced Ejection Fraction): Heart’s pumping power is decreased (EF < 40%)
• HFpEF (Preserved Ejection Fraction): Pumping power is normal but filling is impaired (EF ≥ 50%)
• HFmrEF (Mid-Range EF): Ejection fraction between 40-49%

2. Right-Sided Heart Failure

• The right ventricle pumps blood to the lungs, but this function is impaired in right-sided failure
• Usually develops secondary to left-sided heart failure

3. Biventricular (Two-Sided) Failure

• Both left and right ventricles are affected
• The most severe form with more serious prognosis

Causes of Heart Failure

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Many conditions and diseases can lead to heart failure:

Primary Causes

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1. Coronary Artery Disease

• Most common cause (60-70%)
• Reduced blood flow to heart muscle
• Heart muscle damage following heart attack

2. Hypertension (High Blood Pressure)

• Long-term high blood pressure strains the heart
• Heart muscle thickens and stiffens
• Pumping capacity decreases over time

3. Heart Valve Diseases

• Stenosis or regurgitation increases heart workload
• Aortic stenosis and mitral regurgitation are particularly important

4. Cardiomyopathies

• Dilated cardiomyopathy: Heart enlarges and weakens
• Hypertrophic cardiomyopathy: Heart muscle abnormally thickens
• Restrictive cardiomyopathy: Heart walls stiffen

Secondary and Contributing Factors

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• Diabetes: Micro and macrovascular complications
• Obesity: Increases heart workload
• Sleep apnea: Nighttime oxygen drops strain the heart
• Alcohol use: Alcoholic cardiomyopathy
• Viral infections: Myocarditis (heart muscle inflammation)
• Thyroid disorders: Hyperthyroidism or hypothyroidism
• Kidney failure: Fluid and electrolyte imbalance
• Chemotherapy drugs: Cardiotoxicity

Heart Failure Symptoms

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Heart failure symptoms vary depending on disease severity and affected heart region:

Left-Sided Heart Failure Symptoms

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Shortness of Breath (Dyspnea)

• Begins with exertion, progresses to rest
• Worsening breathlessness when lying down (orthopnea)
• Sudden nighttime awakening with breathlessness (paroxysmal nocturnal dyspnea)

Fatigue and Weakness

• Fatigue that limits daily activities
• Muscle weakness
• Difficulty concentrating

Cough

• Dry, irritating cough
• Cough worsening when lying down
• Pink, frothy sputum in advanced cases

Right-Sided Heart Failure Symptoms

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Peripheral Edema

• Swelling in ankles and legs
• Edema increasing toward evening
• Pitting when pressed with finger

Abdominal Swelling

• Liver enlargement (hepatomegaly)
• Fluid accumulation in abdomen (ascites)
• Loss of appetite and nausea

Neck Vein Distension

• Jugular venous distension (JVD)
• More prominent when lying down

NYHA Functional Classification

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The New York Heart Association (NYHA) classification is used to assess clinical status:

Diagnostic Methods

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Heart failure diagnosis is made through a combination of clinical evaluation and various tests:

Physical Examination

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• Heart and lung sounds (rales, murmurs, S3 gallop)
• Checking for leg edema
• Neck vein assessment
• Liver size evaluation

Laboratory Tests

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BNP/NT-proBNP

• Most important biomarker for heart failure
• Valuable for diagnosis and monitoring
• NT-proBNP > 125 pg/mL is significant

Other Tests

• Complete blood count (anemia screening)
• Kidney and liver function tests
• Electrolytes (sodium, potassium)
• Thyroid function tests
• Fasting blood glucose and HbA1c

Imaging Methods

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Echocardiography

• Gold standard diagnostic method
• Ejection fraction measurement
• Heart valve and wall motion assessment
• Filling pressure estimation

Chest X-Ray

• Cardiomegaly (heart enlargement)
• Pulmonary congestion signs
• Pleural effusion

Coronary Angiography

• Coronary artery disease evaluation
• Revascularization planning

Cardiac MRI

• Myocardial structure and function
• Fibrosis and scar tissue detection
• Cardiomyopathy classification

ECG (Electrocardiography)

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• Rhythm abnormalities
• Conduction defects (left bundle branch block)
• Previous infarction signs
• Heart enlargement indicators

Heart Failure Treatment

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Heart failure treatment is planned according to disease type, severity, and underlying cause:

Lifestyle Modifications

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Salt Restriction

• Daily sodium intake < 2 grams
• Avoid processed foods
• Prefer home-cooked meals

Fluid Control

• Daily fluid intake 1.5-2 liters
• Stricter restriction in severe cases
• Daily weight monitoring is important

Exercise

• Regular, moderate-intensity aerobic exercise
• Cardiac rehabilitation programs
• Improves exercise tolerance

Smoking Cessation

• Absolute necessity
• Slows disease progression

Medication Therapy

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1. ACE Inhibitors / ARBs

• Reduces workload on the heart
• Improves survival
• Examples: Ramipril, enalapril, losartan, valsartan

2. Beta Blockers

• Slows heart rate
• Protects heart muscle
• Metoprolol, carvedilol, bisoprolol

3. Mineralocorticoid Receptor Antagonists (MRA)

• Spironolactone, eplerenone
• Reduces sodium and water retention
• Prevents fibrosis

4. SGLT2 Inhibitors

• Dapagliflozin, empagliflozin
• Effective in non-diabetic patients too
• Reduces hospitalization

5. Diuretics

• Removes fluid accumulation
• Important for symptom control
• Furosemide, torasemide

6. ARNI (Sacubitril/Valsartan)

• Superior to ACE inhibitors in HFrEF
• Reduces mortality and hospitalization

7. Digoxin

• Heart rate control in atrial fibrillation patients
• Symptom improvement

8. Ivabradine

• For sinus rhythm with rate > 70/min
• Provides additional rate control

Device Therapies

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ICD (Implantable Cardioverter Defibrillator)

• For patients at high risk of sudden cardiac death
• EF ≤ 35% and NYHA II-III despite optimal therapy
• Delivers life-saving shocks

CRT (Cardiac Resynchronization Therapy)

• For patients with left bundle branch block and EF ≤ 35%
• Enables synchronized heart contraction
• Biventricular pacing

CRT-D (CRT + ICD)

• Both resynchronization and defibrillation
• Most comprehensive device therapy

Advanced Treatment Options

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Left Ventricular Assist Devices (LVAD)

• As bridge to heart transplant
• Destination therapy (for transplant-ineligible patients)
• Mechanically supports pump function

Heart Transplantation

• For end-stage heart failure
• When all other treatments fail
• Dependent on organ availability

When to See a Doctor

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Consult a cardiologist if you experience:

• Unusual shortness of breath during exercise or climbing stairs
• Unexplained swelling in legs or abdomen
• Nighttime breathlessness that wakes you
• Persistent fatigue and weakness
• Rapid weight gain over a few days (2-3 kg)
• Regular check-ups if you have heart disease history

Prognosis and Life Expectancy

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Heart failure prognosis depends on many factors:

Positive Prognostic Factors

• Early diagnosis and treatment
• Medication adherence
• Lifestyle modifications
• Higher ejection fraction
• Younger age

Negative Prognostic Factors

• Very low EF (< 20%)
• Recurrent hospitalizations
• Kidney failure
• Diabetes
• Advanced age

With modern treatments, heart failure patients can lead quality lives for many years.

Frequently Asked Questions (FAQ)

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Schedule an Appointment

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If you’re experiencing heart failure symptoms or have risk factors, you can schedule an appointment for comprehensive cardiac evaluation.